General Thoracic and Cardiovascular Surgery最新文献

{"title":"Harvest of a pedicled omental flap preserving the right gastroepiploic artery for gastric conduit reconstruction in multistage surgery for aortoesophageal fistula.","authors":"Hiroshi Okamoto, Yusuke Taniyama, Chiaki Sato, Yohei Ozawa, Hirotaka Ishida, Takashi Kamei","doi":"10.1007/s11748-026-02317-4","DOIUrl":"10.1007/s11748-026-02317-4","url":null,"abstract":"<p><p>Aortoesophageal fistula is a rare but highly fatal condition. Thoracic endovascular aortic repair has led to improved early outcomes. However, subsequent aortic replacement, esophagectomy, and gastrointestinal reconstruction are required to achieve long-term survival. Conventional pedicled flaps using both gastroepiploic arteries can prevent gastric conduit reconstruction, requiring small or large intestinal substitutes associated with greater surgical invasiveness. We developed the pedicled omental flap technique preserving the right gastroepiploic artery, which enabled simultaneous gastric conduit preparation and omental harvest in a multistage surgery. After a specific interval following esophagectomy, the omental flap was mobilized while preserving right gastroepiploic perfusion, and a gastric conduit was created. Both were evaluated via indocyanine green imaging. The omental flap was delivered into the thoracic cavity for later graft coverage. Meanwhile, the gastric conduit was left in situ for delayed reconstruction. This method reduced invasiveness and facilitated staged treatment of aortoesophageal fistula with improved surgical flexibility.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"917-921"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148137703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-term outcomes of xenopericardial roll graft replacement for thoracic and thoracoabdominal native aortic and prosthetic graft infection: a single-centre retrospective study.","authors":"Yusuke Inaba, Hidehito Endo, Yu Takahashi, Sachito Minegishi, Teppei Shimasaki, Daisuke Kurai, Harumasa Nakazawa, Norihiko Ohura, Hirohisa Takeuchi, Nobutsugu Abe, Hiroshi Kubota","doi":"10.1007/s11748-026-02386-5","DOIUrl":"10.1007/s11748-026-02386-5","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the feasibility and mid-term outcomes of in situ aortic reconstruction using xenopericardial roll grafts for thoracic and thoracoabdominal native aortic and prosthetic graft infection.</p><p><strong>Methods: </strong>This retrospective single-centre study included consecutive patients who underwent xenopericardial roll graft replacement, including branched graft reconstruction and/or tissue filling, between 2010 and 2024. A multidisciplinary treatment strategy was adopted.</p><p><strong>Results: </strong>This study included 21 patients who underwent 22 procedures (median age, 67 years; interquartile range, 63.75-73.75). On a procedure basis, the indications were infectious aortic aneurysm in 4 procedures and prosthetic graft infection in 18 procedures. Replacement sites included the ascending aorta (n = 4), aortic arch (n = 11), descending aorta (n = 6), and thoracoabdominal aorta (n = 1). Tissue filling was performed in 12 procedures. The 30-day and operative mortality rates were 13.6% (3/22) and 18.2% (4/22), respectively. After excluding the three procedures with 30-day mortality, 19 procedures were included in the Kaplan-Meier analyses. Aorta-related mortality occurred in 10.5% (2/19), both due to fungal reinfection. The median follow-up was 53.6 months (IQR, 20-80.5; maximum, 132 months). The estimated survival rates at 1, 3, 5, and 7 years were 94%±6%, 76%±11%, 70%±11%, and 56%±15%, respectively. Xenopericardial roll graft-related structural complications included suture-line pseudoaneurysm (n = 2), suture-line rupture (n = 1), branch kinking (n = 1), xenopericardial roll graft body pseudoaneurysm (n = 1), and proximal anastomotic pseudoaneurysm (n = 1). No thromboembolism or graft calcification was observed.</p><p><strong>Conclusions: </strong>Xenopericardial roll graft replacement was technically feasible as part of a multidisciplinary staged strategy in selected patients with thoracic and thoracoabdominal native aortic or prosthetic graft infection. However, fungal reinfection and xenopericardial roll graft-related structural complications remain important concerns, and careful long-term surveillance is required.</p><p><strong>Clinical trial registration: </strong>Not applicable. This study is a retrospective observational study.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A critical appraisal of \"Preoperative extracorporeal membrane oxygenation is associated with improved outcomes in emergent surgical pulmonary embolectomy\".","authors":"Abdul Basit Munir, Haider Imran, Nashmia Faraz","doi":"10.1007/s11748-026-02385-6","DOIUrl":"https://doi.org/10.1007/s11748-026-02385-6","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simplified left atrial maze through the amputated left atrial appendage: methodological considerations.","authors":"Priyanka Ochani, Ayushman Ochani, Konain Fatima","doi":"10.1007/s11748-026-02390-9","DOIUrl":"https://doi.org/10.1007/s11748-026-02390-9","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of infectious complications in tracheal defects using a biodegradable polylactide patch: an experimental study.","authors":"Andrei V Nikulin, Ekaterina V Blinova, Alexandra A Fomichevа, Tatiana N Sotnikova, Polina A Kovaleva, Anna I Cheremnykh, Iliya N Sorokvasha, Ivar S Struts, Kirill D Blinov, Tatiana V Khorobrykh","doi":"10.1007/s11748-026-02388-3","DOIUrl":"https://doi.org/10.1007/s11748-026-02388-3","url":null,"abstract":"<p><strong>Objective: </strong>Tracheal surgery is associated with substantial morbidity, and anastomotic failure can lead to life-threatening infectious complications such as mediastinitis. This study aimed to evaluate whether a biodegradable polylactide patch can close an experimental tracheal defect in mice and prevent such complications.</p><p><strong>Methods: </strong>In 30 male BALB/c mice, a window defect was created in the anterior tracheal wall. In Group 1 (control, n = 15) the defect was closed with two interrupted sutures only. In Group 2 (experimental, n = 15) the defect was repaired using an electrospun polylactide (PLA) patch secured with two interrupted sutures. Postoperative monitoring included daily semiquantitative clinical scoring (6 parameters, 0-3 scale) in addition to survival and histological assessment on days 7, 14, and 21.</p><p><strong>Results: </strong>All mice in the experimental group survived with no signs of infection and clinical scores ≤ 1. In the control group, 5 of 15 mice developed cervical phlegmon (two died spontaneously, three were euthanized with purulent exudate); the other 10 mice without phlegmon survived. Histologically, the control group exhibited persistent inflammation, tissue disorganisation, and incomplete epithelial regeneration (flattened epithelium with occasional ciliated patches). The PLA patch group showed progressive polymer degradation, minimal inflammation, and complete restoration of a ciliated respiratory epithelium by day 21.</p><p><strong>Conclusion: </strong>The PLA patch prevented infectious complications and mortality, promoted full ciliated epithelialization, and demonstrated high biocompatibility, supporting its use in tracheal reconstructive surgery.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy and application of noninvasive computed tomography-guided skin marking in surgery for peripheral small pulmonary nodules.","authors":"Toshinari Ito, Takahiro Ichino, Yuya Iwata, Toshiki Okasaka","doi":"10.1007/s11748-026-02377-6","DOIUrl":"https://doi.org/10.1007/s11748-026-02377-6","url":null,"abstract":"<p><strong>Objective: </strong>Intraoperative localization of small peripheral pulmonary nodules can be challenging due to the size, characteristics, or depth of nodules. This study introduced a computed tomography (CT)-guided skin marking method and evaluated its feasibility and accuracy.</p><p><strong>Methods: </strong>From January 2017 to January 2026, 89 patients underwent CT-guided skin marking followed by wedge lung resection. Eligible nodules were located in the outer third of the lung and measured ≤ 1 cm in diameter or ≤ 2 cm in maximum diameter, with a consolidation-to-tumor ratio of ≤ 0.25 were considered eligible. CT-guided skin marking was performed a day before surgery. During the operation, a port was created at the marked skin site, and a dyed cotton swab was used to mark the visceral pleura. Wedge resection was conducted using the pigmented mark as a guide. Distance from the marker to the visceral pleural surface directly above the lesion (hereinafter referred to as distance) was measured, and factors associated with a value of ≥ 10 mm were identified using logistic regression analysis.</p><p><strong>Results: </strong>All nodules were completely resected without complications. The median distance was 6 (range: 0-25) mm. A greater chest wall thickness and a larger port insertion angle were significantly associated with distance of ≥10 mm.</p><p><strong>Conclusions: </strong>CT-guided skin marking is a simple and safe technique and does not require special equipment. Notably, distance increases in cases involving thick chest walls or large port insertion angles. Hence, this method can be a reliable and widely applicable approach for the accurate resection of small peripheral pulmonary nodules.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary revascularisation in British Columbia: 25-year trends in volume and modality.","authors":"Justin Blackman, Aaryan Dwivedi, Stephanie Quon, Laura Arbour, Andrew D Krahn, Kanwal Kumar, Yousif Ahmad, Markus B Sikkel","doi":"10.1007/s11748-026-02375-8","DOIUrl":"https://doi.org/10.1007/s11748-026-02375-8","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate 25-year trends in coronary revascularization volumes and outcomes in British Columbia (BC).</p><p><strong>Methods: </strong>All revascularizations in BC, Canada, between 2000-2024 were identified using provincial administrative datasets within the single-payer public health system serving 5.5 million persons. Cases were defined as any combination of PCI and/or CABG occurring within 60 days, categorized as One-Time PCI, Serial PCI, CABG, or Combination CABG + PCI. Temporal trends were assessed using linear regression and changepoint analysis. Statistical significance was set at α = 0.05.</p><p><strong>Results: </strong>We identified 239,461 revascularization cases involving 563,994 vessel revascularizations. Annual case volumes per capita rose until 2005, remained stable until 2017, and then declined sharply (-9.06/100,000/year, p < 0.001). PCI and CABG accounted for 73.6% and 24.9% of cases, respectively. CABG use declined until the mid-2000s and stabilized thereafter at 25% of cases (15% for acute MI). Mean number of vessels treated per case increased modestly over time (+ 0.01 vessels/case/year, p = 0.003). Mean age at revascularization increased + 0.17 years/year (p < 0.001) from 67.2 to 71.1. Thirty-day mortality was 2.21%; 30-day CABG mortality declined annually (-0.04%/year, p < 0.001) from 2.14% to 1.46%, but PCI mortality increased (+ 0.05%/year, p < 0.001) from 1.60% to 2.46%.</p><p><strong>Conclusions: </strong>PCI has predominated since 2001, whereas CABG utilization stabilized after 2005. BC has experienced an ongoing revascularization recession since 2017.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148827312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and surgical outcomes of thoracoscopic surgery for spontaneous pneumothorax with scope manipulation performed by clinical engineers: a retrospective comparative study.","authors":"Yoshifumi Shimada, Junpei Kido, Shinichi Sasayama","doi":"10.1007/s11748-026-02382-9","DOIUrl":"https://doi.org/10.1007/s11748-026-02382-9","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility and surgical outcomes of thoracoscopic surgery for spontaneous pneumothorax (SP) with scope manipulation performed by clinical engineers (CEs) as the initial implementation of task shifting in thoracoscopic surgery at our institution.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with SP who underwent thoracoscopic surgery between April 2023 and March 2026. Baseline characteristics and surgical outcomes were compared between procedures with scope manipulation performed by CEs and those with scope manipulation performed by surgeons.</p><p><strong>Results: </strong>The CE group included 38 patients and the Surgeon group included 37 patients, with no statistically significant differences in baseline patient characteristics. There were also no statistically significant differences in operative time, blood loss, postoperative drainage duration, postoperative hospital stay, complication rate, and recurrence-free survival between the groups (operative time: 60.0 ± 22.9 vs. 56.4 ± 25.1 min, P = 0.52; blood loss: 10 [10-10] vs. 10 [10-10] mL, P = 0.15; postoperative drainage duration: 1.4 ± 1.1 vs. 1.2 ± 0.4 days, P = 0.19; postoperative hospital stay: 4.6 ± 5.2 vs. 2.9 ± 2.6 days, P = 0.09; complication rate: 13.2% vs. 5.4%, P = 0.43; recurrence-free survival: log-rank P = 0.24).</p><p><strong>Conclusions: </strong>Thoracoscopic surgery for SP appears feasible when scope manipulation is performed by CEs, with no statistically significant differences in the evaluated surgical outcomes between the CE and Surgeon groups.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diaphragmatic overlay reconstruction using a bovine pericardial patch (Peri-Guard®): feasibility, safety, and radiographic outcomes.","authors":"Alina Meininger, Tobias Goecke, Patrick Zardo, Arjang Ruhparwar, Tomoyuki Nakagiri","doi":"10.1007/s11748-026-02380-x","DOIUrl":"https://doi.org/10.1007/s11748-026-02380-x","url":null,"abstract":"<p><strong>Background: </strong>Surgical treatment of symptomatic diaphragmatic paralysis or eventration classically relies on suture plication of the elevated hemidiaphragm. We describe an alternative technique-overlay reconstruction of the diaphragm using a bovine pericardial patch (Peri-Guard®) without formal plication sutures-and report its feasibility, safety, and radiographic outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients undergoing diaphragmatic overlay reconstruction with a Peri-Guard® patch at Hannover Medical School between January 2020 and May 2025. Demographic, perioperative, and radiographic data were collected. Diaphragmatic elevation was quantified on chest radiographs using the interdiaphragmatic height difference (IHD) and relative IHD (rIHD). Preoperative and postoperative measurements were compared.</p><p><strong>Results: </strong>Thirteen patients underwent patch-based diaphragmatic overlay reconstruction. Mean age was 60.0 ± 9.3 years, and mean body mass index was 29.4 ± 4.9 kg/m². Dyspnoea was the predominant symptom (84.6%). Mean operative time was 124.7 ± 31.7 min; all patients were extubated in the operating room, and there was no perioperative mortality. Mean IHD decreased from 7.32 ± 2.94 cm preoperatively to - 0.29 ± 2.24 cm postoperatively (p < 0.001); mean rIHD decreased from 31.22 ± 11.49 to - 1.47 ± 9.42% (p < 0.001). Exploratory analyses found no significant association between BMI and postoperative radiographic outcomes.</p><p><strong>Conclusions: </strong>In this small retrospective series, patch-based diaphragmatic overlay reconstruction was technically feasible and was associated with marked early radiographic correction of diaphragmatic elevation. Comparative studies against conventional suture plication are needed to determine relative durability and functional benefit.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148791712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological considerations regarding the prognostic value of the geriatric nutritional risk index in lung transplant waitlist mortality.","authors":"Hashim Nawaz, Aarij Sohail Iqbal","doi":"10.1007/s11748-026-02378-5","DOIUrl":"https://doi.org/10.1007/s11748-026-02378-5","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}